Provider Demographics
NPI:1356354518
Name:CHEN, RU
Entity type:Individual
Prefix:
First Name:RU
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RU
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:142 LARKIN CIRCLE
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3232
Mailing Address - Country:US
Mailing Address - Phone:916-294-0808
Mailing Address - Fax:
Practice Address - Street 1:5200 STOCKTON BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820
Practice Address - Country:US
Practice Address - Phone:916-455-6600
Practice Address - Fax:916-455-4638
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 45837122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist